Cardiac Intensive Care Unit Admission Criteria

723 Pages·2010·28.46 MB·English

Cardiac
Intensive Care
Second Edition
Allen Jeremias, MD, MSc
Assistant Professor, Department of Medicine
Director, Vascular Medicine and Peripheral Intervention
Division of Cardiovascular Medicine
SUNY-Stony Brook School of Medicine
Health Sciences Center
Stony Brook, New York
David L. Brown, MD
Professor, Department of Medicine
Co-Director, Stony Brook Heart Center
Chief, Division of Cardiovascular Medicine
SUNY-Stony Brook School of Medicine
Health Sciences Center
Stony Brook, New York
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
CARDIAC INTENSIVE CARE ISBN: 978-1-4160-3773-6
Copyright © 2010, by Saunders, an imprint of Elsevier Inc.
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Notice
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or
appropriate. Readers are advised to check the most current information provided (i) on procedures
featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose
or formula, the method and duration of administration, and contraindications. It is the responsibility of
the practitioner, relying on his or her own experience and knowledge of the patient, to make diagnoses,
to determine dosages and the best treatment for each individual patient, and to take all appropriate safety
precautions. To the fullest extent of the law, neither the Publisher nor the Editors assume any liability
for any injury and/or damage to persons or property arising out of or related to any use of the material
contained in this book.
The Publisher
Library of Congress Cataloging-in-Publication Data
Cardiac intensive care / [edited by] Allen Jeremias, David L.
Brown. — 2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4160-3773-6
1. Cardiac intensive care. I. Jeremias, Allen. II. Brown, David L.
(David Lloyd).
[DNLM: 1. Heart Diseases—therapy. 2. Intensive
Care—methods. WG 166 C263 2010]
RC684.C36C37 2010
616.1'2028--dc22
2010000913
Executive Publisher: Natasha Andjelkovic
Developmental Editor: Bradley McIlwain
Project Manager: Jagannathan Varadarajan
Design Direction: Steven Stave
Publishing Services Manager: Hemamalini Rajendrababu
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Dedicated to my parents, Dr. Andreas and Susanne Jeremias, who always supported
me in every endeavor and made me who I am today; and to my grandfather,
Dr. Nicolaus Jeremias, whose unwavering dedication to patient care has set the
standard that I aspire to.
Allen Jeremias
This edition is dedicated to my mentor, Kanu Chatterjee, MBBS, on the occasion of his
retirement from the Division of Cardiovascular Medicine at University of California,
San Francisco, where he inspired and taught generations of trainees the art, science,
and humanity of medicine.
David L. Brown
Foreword
The care of acutely ill cardiac patients has evolved over the Throughout this progress, coronary care units evolved from
past 40 years through a series of landmark developments and specialized areas catering to patients with acute ischemic syn-
milestones. Coronary intensive care began in the 1960s with dromes to a place where we now take care of the ever-increasing
the introduction of electrocardiogram (ECG) monitoring for population of patients with other critical cardiovascular ill-
patients with acute myocardial infarction (MI). ECG moni- nesses, such as acute and severe chronic heart failure, chronic
toring coupled with the introduction of antiarrhythmic inter- pulmonary hypertension, life-threatening cardiac dysrhythmias,
ventions (cardioversion, defibrillation, and lidocaine) led to a aortic dissection, and other diagnoses. A modern coronary care
dramatic decrease in the mortality of patients with acute MI, unit is, in reality, a cardiac intensive care unit.
largely through a reduction of in-hospital ventricular dysrhyth- This second edition of Cardiac Intensive Care, presented in
mias. This was the first major milestone in the care of patients a new full-color design, edited by Allen Jeremias, MD, MSc, and
with acute MI. At this time, hemodynamic dysfunction and David L. Brown, MD, provides a state-of-the-art compendium
pump failure emerged as the leading causes of death in acute MI. summarizing all of the progress that has been made in the di-
In the early 1970s, the introduction of bedside pulmonary agnosis, assessment, and treatment of patients with critical car-
artery catheterization, by Willie Ganz and Jeremy Swan at the diac illnesses over the past several years. The 52 chapters and 3
Cedars-Sinai Medical Center, made possible accurate assessment appendices are written by experienced authors who have made
of hemodynamic dysfunction in critically ill cardiac patients. important contributions in their respective fields. Nine new
This landmark development spawned a new era of coronary chapters have been added in this new edition dealing with topics
care that led to better assessment and management of pump including quality assurance and improvement, physical exami-
dysfunction, stimulating the introduction of afterload-reducing nation, mechanical treatments for acute ST segment elevation
therapy for heart failure. Around the same time, the concept of MI, non–ST segment elevation MI, and management of post–
infarct size as a major determinant of ventricular dysfunction cardiac surgery patients. The convenience of full-text online ac-
and prognosis began in the experimental laboratory, triggering cess at expertconsult.com is an added bonus.
a search for interventions to limit infarct size in experimental The editors have captured the essence of what is the state-of-
animals. The results of various therapies in this regard were in- the-art in a rapidly evolving and dynamic field. The contents of
consistent in the laboratory and in the clinical arena. this text provide a nice blend of pathophysiology and the more
The next major milestone came in the late 1970s and early pragmatic issues of actual intensive cardiac care. In addition to
1980s, when the role of coronary thrombosis as the proximate dealing in detail with the issues of acute cardiac problems, this
cause of acute MI became firmly established through the land- text provides a broader perspective by including many useful
mark study of Marcus DeWood, then a trainee in cardiology. chapters that deal with critical care issues of a more general na-
With this observation and the elegant early experimental work ture, such as airway and ventilator management, resuscitation,
of many investigators, the importance of timely reperfusion as dialysis, and ultrafiltration. The editors and the authors are to
a powerful method for infarct size limitation was recognized. be commended for having produced an up-to-date and useful
The focus on reperfusion, initially with intracoronary and subse- treatise on cardiovascular critical care.
quently with intravenous thrombolysis and more recently with P. K. Shah, MD
primary angioplasty, as a means of reducing infarct size and de- Shapell and Webb Chair and Director
creasing mortality revolutionized contemporary care of patients Division of Cardiology and Oppenheimer Atherosclerosis
with developing MI. Research Center
This advance represented another major milestone in coro- Cedars-Sinai Heart Institute
nary care. All this stepwise progress over the years has led to Los Angeles, California
a substantive and steadily declining mortality for patients with
acute MI. The past several years have witnessed an explosion
in our knowledge of vascular biology, atherogenesis, plaque
disruption and thrombosis, and the concept of acute coronary
syndromes. These concepts have led to dramatic improvements
in our ability to diagnose and manage patients with unstable an-
gina with potent antithrombotic strategies ranging from aspirin
and heparin to platelet receptor antagonists and direct thrombin
inhibitors to angioplasty and stent implantation.
vii
Preface
Since the publication of the first edition of Cardiac Intensive peripheral arterial procedures, atrial and ventricular ablations,
Care, there have been considerable changes in the level of care pacemaker and defibrillator implantations, and cardiac imaging.
and the complexity of therapies provided in the cardiac inten- The cardiac intensivist is required to make informed decisions
sive care unit (CICU). To reflect these changes appropriately, about the potential benefit versus the risks of referring patients
the second edition of Cardiac Intensive Care has not only been for these procedures and to interpret the data derived from
updated, but also completely restructured with many new chap- these procedures adequately. In addition, adding to the dynamic
ters. Given that most CICU admissions are still related to coro- environment, optimal patient care in the CICU is delivered via
nary artery disease and its acute manifestations, one major focus a multidisciplinary approach involving physicians, nurses, ethi-
of this text remains the diagnosis and therapeutic options for cists, respiratory therapists, nutritionists, physical therapists,
patients with acute coronary syndromes. Section III, Coronary and social workers. The goal of this second edition of Cardiac
Artery Disease, is divided into Acute Myocardial Infarction, Intensive Care is to provide a comprehensive, conceptual, yet
Complications of Acute Myocardial Infarction, and Complica- practical and evidence-based text for all specialties involved in
tions of Percutaneous Interventional Procedures. We recognize, patient care in a CICU.
however, the ever-increasing multifaceted disease states that are The editors thank Natasha Andjelkovic from Elsevier for her
cared for in the CICU and have included sections on Noncoro- tireless efforts and her ongoing encouragement throughout this
nary Diseases, Pharmacologic Agents in Cardiac Intensive Care endeavor. Additionally, we express our deep appreciation to all
Unit, and Advanced Diagnostic and Therapeutic Techniques. the contributing authors. Without their expertise, dedication,
The evidence base for practice in the CICU is expanding and time commitment, this book would not have been possible.
rapidly, placing high demands on the daily “rounders.” The field Allen Jeremias
of cardiovascular medicine has expanded to subsume multiple David L. Brown
subspecialties and a multitude of procedures, including percu-
taneous coronary intervention, percutaneous valve procedures,
ix
Contributors
Masood Akhtar, MD Daniel Baram, MD
Professor of Medicine Pulmonary/Critical Care Medicine
Electrophysiology Laboratories of Aurora Sinai/Aurora Mather Memorial Hospital
St. Luke’s Medical Centers Port Jefferson, New York
University of Wisconsin School of Medicine and Public Mechanical Ventilation in the Cardiac Care Unit
Health-Milwaukee Clinical Campus
Milwaukee, Wisconsin Eric R. Bates, MD
Sudden Cardiac Death Professor of Internal Medicine
Division of Cardiovascular Diseases
Ibrahim O. Almasry, MD Department of Internal Medicine
Assistant Professor of Medicine University of Michigan
Stony Brook University Medical Center Ann Arbor, Michigan
Stony Brook, New York Cardiogenic Shock
Antiarrhythmic Electrophysiology and Pharmacotherapy
Richard C. Becker, MD
Professor of Medicine
Jayaseelan Ambrose, MD
Division of Cardiovascular Medicine
Western Pennsylvania Cardiology Associates
Duke University Medical Center and Duke Clinical Research
Du Bois, Pennsylvania
Institute
Acute Presentations of Valvular Heart Disease
Durham, North Carolina
Evolution of the Coronary Care Unit: Past, Present, and Future
William R. Auger, MD
Division of Pulmonary and Critical Care Medicine
Andreia Biolo, MD
University of California, San Diego School of Medicine
Boston University School of Medicine
University of California, San Diego Medical Center
Boston Medical Center
San Diego, California
Boston, Massachusetts
Pulmonary Hypertension
Inotropic and Vasoactive Agents in the Cardiac Intensive Care Unit
Wendy J. Austin, MD David L. Brown, MD
Heart Center of the Rockies Professor, Department of Medicine
Loveland, Colorado Co-Director, Stony Brook Heart Center
Acute Presentations of Valvular Heart Disease Chief, Division of Cardiovascular Medicine
Stony Brook School of Medicine
Nitish Badhwar, MBBS Health Sciences Center
Division of Cardiology Stony Brook, New York
San Francisco General Hospital Pathophysiology of Acute Coronary Syndromes: Plaque
University of California, San Francisco Rupture and Atherothrombosis; Diagnosis of Acute
San Francisco, California Myocardial Infarction; Right Ventricular Infarction; Invasive
Pacemaker and Implantable Cardioverter Defibrillator Hemodynamic Monitoring in the Cardiac Intensive Care Unit
Emergencies
David A. Calhoun, MD
Rajesh Banker, MD, MPH Vascular Biology and Hypertension Program
Division of Cardiology University of Alabama at Birmingham
San Francisco General Hospital Birmingham, Alabama
University of California, San Francisco Hypertensive Emergencies
San Francisco, California
Pacemaker and Implantable Cardioverter Defibrillator
Emergencies
xi
Contributors
William B. Cammarano, MD Wilson S. Colucci, MD
Assistant Clinical Professor of Anesthesia Professor of Medicine and Physiology
University of California, San Francisco Boston University School of Medicine
San Francisco General Hospital Chief, Cardiovascular Medicine
San Francisco, California Director, Cardiomyopathy Program
Analgesics, Tranquilizers, and Sedatives Boston Medical Center
Boston, Massachusetts
Mark D. Carlson, MD Inotropic and Vasoactive Agents in the Cardiac Intensive Care Unit
Professor of Medicine
University Hospitals of Cleveland and Case Western Reserve Melissa A. Daubert, MD
University Clinical Fellow, Cardiovascular Medicine
Cleveland, Ohio Stony Brook University Medical Center
Ventricular and Supraventricular Arrhythmias in Acute Stony Brook, New York
Myocardial Infarction Diagnosis of Acute Myocardial Infarction
Marc Chalaby, MD Harold L. Dauerman, MD
University of Texas Health Science Center Professor of Medicine
San Antonio, Texas University of Vermont
Acute Respiratory Failure Director, Cardiovascular Catheterization Laboratories
South Burlington, Vermont
Kanu Chatterjee, MB, FRCP, FCCP, FACC, MACP Reperfusion Therapies for Acute ST Segment Elevation
Ernest Gallo Distinguished Professor of Medicine Myocardial Infarction
Director, Chatterjee Center for Cardiac Research
University of California, San Francisco Megan DeMott, MD
San Francisco, California Clinical Instructor
Mechanical Complications of Acute Myocardial Infarction Division of Medical Toxicology
University of California, San Diego Medical Center
Melvin D. Cheitlin, MD San Diego, California
Emeritus Professor of Medicine Overdose of Cardiotoxic Drugs
University of California, San Francisco
San Francisco General Hospital Raghuveer Dendi, MD
San Francisco California Cardiovascular Division
Hemodynamically Unstable Presentations of Congenital Heart Harvard-Thorndike Electrophysiology Institute and
Disease in Adults Arrhythmia Service
Beth Israel Deaconess Medical Center
Tony M. Chou, MD Boston, Massachusetts
Associate Professor of Medicine Conduction Disturbances in Acute Myocardial Infarction
University of California, San Francisco
San Francisco Veterans Administration Medical Center Martin E. Edep, MD
San Francisco, California Private Practice
Mechanical Complications of Acute Myocardial Infarction Boca Raton, Florida
Pathophysiology of Acute Coronary Syndromes: Plaque Rupture
Richard F. Clark, MD and Atherothrombosis
Professor of Medicine
Division of Medical Toxicology Stephen G. Ellis, MD
University of California, San Diego Medical Center Section Head, Invasive/Interventional Cardiology
San Diego, California Department of Cardiology
Overdose of Cardiotoxic Drugs The Cleveland Clinic Foundation
Cleveland, Ohio
Robert J. Cody, MD Recurrent Ischemia after Reperfusion Therapy for Acute
Global Director for Scientific Affairs Myocardial Infarction
Cardiovascular Therapeutic Area
Merck Research Laboratories Gordon A. Ewy, MD
Merck & Company Professor and Chief, Department of Cardiology
Whitehouse Station, New Jersey Director, University of Arizona Sarver Heart Center
Diuretics and Newer Therapies for Sodium and Edema University of Arizona College of Medicine
Management in Acute Decompensated Heart Failure Tucson, Arizona
Cardiocerebral Resuscitation, Defibrillation, and Cardioversion
xii
Contributors
Peter F. Fedullo, MD Michael M. Givertz, MD
Division of Pulmonary and Critical Care Medicine Assistant Professor of Medicine
University of California, San Diego School of Medicine Harvard Medical School
University of California, San Diego Medical Center Co-Director, Cardiomyopathy and Heart Failure Program
San Diego, California Division of Cardiovascular Medicine
Pulmonary Hypertension Brigham and Women’s Hospital
Boston, Massachusetts
Patrick W. Fisher, DO, PhD Inotropic and Vasoactive Agents in the Cardiac Intensive Care
Associate Medical Director, Utah Transplantation Affiliated Unit
Hospitals (UTAH) Cardiac Transplant Program at
Intermountain Medical Center Prospero Gogo, Jr., MD
Associate Cardiology Director, Utah Artificial Heart Program Assistant Professor of Medicine
Intermountain Medical Center University of Vermont
Murray, Utah South Burlington, Vermont
Cardiac Transplantation Reperfusion Therapies for Acute ST Segment Elevation
Myocardial Infarction
Elyse Foster, MD
Professor of Medicine Nora Goldschlager, MD
Araxe Vilensky Chair in Medicine Division of Cardiology
Director, Adult Congenital Heart Disease Service San Francisco General Hospital
University of California, San Francisco University of California, San Francisco
San Francisco, California San Francisco, California
Hemodynamically Unstable Presentations of Congenital Heart Pacemaker and Implantable Cardioverter Defibrillator
Disease in Adults Emergencies
William H. Gaasch, MD Barry H. Greenberg, MD
Professor of Medicine Professor of Medicine
University of Massachusetts Medical Center Director, Heart Failure/Cardiac Transplantation Program
Lahey Hitchcock Medical Center University of California, San Diego Medical Center
Burlington, Massachusetts San Diego, California
Acute Heart Failure and Pulmonary Edema Acute Presentations of Valvular Heart Disease
Christopher J. Gallagher, MD David Gregg, MD
Associate Professor of Anesthesia Assistant Professor of Medicine
Department of Anesthesiology Co-Director, Adult Congenital Heart Disease Program
Stony Brook University Medical Center Medical University of South Carolina
Stony Brook, New York Charleston, South Carolina
Vascular Access in the Intensive Care Unit Hemodynamically Unstable Presentations of Congenital Heart
Disease in Adults
C. Michael Gibson, MS, MD
Associate Professor of Medicine Luis Gruberg, MD
Harvard Medical School Director, Cardiac Catheterization Laboratories
Director, TIMI Core Laboratories and Data Coordinating Professor of Medicine
Center Stony Brook University Medical Center
Boston, Massachusetts Stony Brook, New York
Anticoagulation: Antithrombin Therapy Intra-Aortic Balloon Pump Counterpulsation
Timothy Gilligan, MD George Gubernikoff, MD
Director, Late Effects Clinic Director, Clinical Cardiac Services
Program Director, Hematology-Oncology Fellowship Medical Director, Center for Aortic Diseases
Taussig Cancer Institute Winthrop-University Hospital
The Cleveland Clinic Foundation Mineola, New York
Cleveland, Ohio Physical Examination in the Cardiac Intensive Care Unit
Ethical Issues of Care in the Cardiac Intensive Care Unit
John Hammock, MD
Cardiovascular Medicine
Blessing Physician Services
Quincy, Illinois
Antiplatelet Therapy
xiii
Contributors
Maureane Hoffman, MD, PhD Abdallah G. Kfoury, MD
Pathology and Laboratory Medicine Service Medical Director, Utah Transplantation Affiliated Hospitals
Durham Veterans Affairs Medical Center (UTAH) Cardiac Transplant Program at Intermountain
Durham, North Carolina Medical Center
Regulation of Hemostasis and Thrombosis Cardiology Director, Utah Artificial Heart Program
Intermountain Medical Center
Stuart J. Hutchison, MD, FRCPC, FACC, FAHA, FASE Murray, Utah
Division of Cardiology Cardiac Transplantation
Foothills Medical Center
University of Calgary Neal S. Kleiman, MD, FACC
Calgary, Alberta, Canada Professor of Medicine
Mechanical Complications of Acute Myocardial Infarction Director, Cardiac Catheterization Laboratories
The Methodist Debakey Heart and Vascular Center
Allen Jeremias, MD, MSc Houston, Texas
Assistant Professor, Department of Medicine Diagnosis and Treatment of Complications of Coronary and
Director, Vascular Medicine and Peripheral Intervention Valvular Interventions
Division of Cardiovascular Medicine
SUNY-Stony Brook School of Medicine Smadar Kort, MD, FACC, FASE
Health Sciences Center Director, Cardiovascular Imaging
Stony Brook, New York Associate Professor of Medicine
Diagnosis of Acute Myocardial Infarction; Elevated Cardiac Stony Brook University Medical Center
Troponin in the Absence of Acute Coronary Syndromes: Stony Brook, New York
Mechanism, Significance, and Prognosis; American College Echocardiography in the CICU
of Cardiology/American Heart Association Management
Guidelines Ioanna Kosmidou, MD
Clinical Fellow, Division of Cardiology/Electrophysiology
Ulrich P. Jorde, MD Brigham and Women’s Hospital
Assistant Professor of Medicine Harvard Medical School
Medical Director, Cardiac Assist Device Program Boston, Massachusetts
Columbia University Medical Center Vascular Complications after Percutaneous Coronary Intervention
New York, New York
Ventricular Assist Device Therapy in Advanced Heart Failure— Rajan Krishnamani, MD, MRCP(UK)
State of the Art Assistant Professor of Medicine
Tufts University School of Medicine
Mark E. Josephson, MD Tufts Medical Center
Herman Dana Professor of Medicine Boston, Massachusetts
Harvard Medical School Acute Heart Failure and Pulmonary Edema
Director, Harvard-Thorndike Electrophysiology Institute and
Arrhythmia Service David M. Leder, MD
Beth Israel Deaconess Medical Center Instructor in Medicine
Boston, Massachusetts Harvard Medical School
Conduction Disturbances in Acute Myocardial Infarction Clinical Fellow in Cardiovascular Disease
Beth Israel Deaconess Medical Center
Bodh I. Jugdutt, MD, MSc, DM, FRCPC, FACC Boston, Massachusetts
Cardiology Division of the Department of Medicine Medical Management of Unstable Angina and Non–ST
University of Alberta Hospital Segment Elevation Myocardial Infarction
Edmonton, Alberta, Canada
Adjunctive Pharmacologic Therapies in Acute Myocardial Infarction William C. Little, MD
Cardiology Section
Dimitri Karmpaliotis, MD Wake Forest University School of Medicine
Piedmont Heart Institute Winston-Salem, North Carolina
Clinical Assistant Professor of Medicine Regulation of Cardiac Output
Medical College of Georgia
Atlanta, Georgia Judith A. Mackall, MD
Vascular Complications after Percutaneous Coronary Intervention Associate Professor of Medicine
University Hospitals of Cleveland and Case Western Reserve
Jason N. Katz, MD University
Fellow, Division of Cardiovascular Medicine Cleveland, Ohio
Duke University Medical Center and Duke Clinical Research Ventricular and Supraventricular Arrhythmias in Acute
Institute Myocardial Infarction
Durham, North Carolina
Evolution of the Coronary Care Unit: Past, Present, and Future
xiv